Category Archives: Health Care

Some health insurance good news, maybe?

Sen. George Barker and Del. Mark Sickles have teamed up to introduce legislation that seems to be good for consumers.  SB 767 and HB 901 tackle the very annoying practice of “surprise” or “balance” billing.  This is what happens when you go into surgery, planned or emergency, and your hospital and doctor are in your insurance network, but the anesthesiologist is not. So, when you get your bill, there is a great big charge for the anesthesiologist.

As the legislators explain in an op-ed in today’s RTD, under the terms of the legislation “the out-of-network providers would be fairly compensated at a rate established at the lower of the median amount that in-network providers would receive, or 125% of what Medicare would reimburse for that service.” I think the patient would still be liable for any co-pays or deductibles.

I have read the bill and it seems favorable to us regular consumers of health care, but my eyes and brain have always tended to glaze over when confronted with legislation dealing with insurance. If anyone out there checks it out and finds that there is some catch in it that makes it not so favorable, please let us know.

— Dick Hall-Sizemore

Lawmakers Coddling Hospital Monopolies

Sen. George Barker (right) and assorted local dignitaries at opening of the Inova Alexandria Hospital in 2012.

by Jim Sherlock

My last essay, “Runaway Costs and Hospital Monopolies,” discussed the fact that Virginians who get their health insurance at work and through the Affordable Care Act website pay the highest premiums in the country. We traced those costs to a number of sources, including the Certificate of Public Need (COPN), Virginia Department of Health (VDH) protection of regional monopolies through its administration of COPN, hospitals acting like monopolies without oversight, and the increasing integration of health insurers and monopoly providers in Virginia’s largest markets.

COPN is the most spectacular example of rent seeking in Virginia history. By the early 1970’s, African-American hospitals had closed because Federal equal-access laws desegregated white hospitals. Black surgeons were looking to open viable practices. The General Assembly enacted COPN in 1973 as a parallel effort by a segregationist Democratic leadership to exclude black doctors and by white hospitals to exclude new competitors of any color. It worked.

The biggest trend in surgery continues to be the migration of surgery from inpatient to outpatient settings. So, if hospitals can’t buy physician practices, they neuter them with a combination of COPN and hyper-aggressive leverage of their regional monopolies and integrated networks, including the ownership of health plans.

Now hospitals want more. Bills introduced in the General Assembly this session would toughen COPN restrictions on competition, drive up costs, reduce access, and negatively impact career opportunities for physicians. Continue reading

Poll Showing Majority Support for COPN Is Meaningless

Source: Virginia Hospital and Healthcare Association

by James A. Bacon

A new Mason-Dixon poll of 625 registered voters commissioned by the Virginia Hospital & Healthcare Association (VHHA) finds that Virginians prefer to keep the Certificate of Public Need program by a three-to-one margin.

“Overall, nearly two-thirds of Virginians (62 percent) express support for the current health care delivery system with COPN in place,” states a press release accompanying the poll. “These findings are consistent with results from a June 2019 statewide poll in which 55 percent of Virginians said they support preserving COPN, compared to just 13 percent in opposition to the program.”

Critics of COPN say that Virginia’s major hospital systems have gamed the regulations to stifle competition with one another, shut down competition with physician-backed ambulatory care centers, and carve out geographic monopolies. Thanks to the regulations, Virginia’s “nonprofit” hospitals enjoy hundreds of millions of dollars in additional profits. Hospitals defend the regulations on the grounds that interlopers would “skim the cream,” providing care to the most profitable patients and dumping less profitable patients on hospitals.

The poll results are a dubious measure of public opinion, however. Continue reading

A Spending Boost We Won’t Object to: Medicaid Fraud Prevention

Participants in the REAL LIFE program.

by James A. Bacon

As legislators ponder the next two-year budget, which incorporates a $2.2 billion-per-year increase in spending (14%) in FY 2022 compared to the current fiscal year, they would do well to take into account a new Medicaid scam.

Medicaid covers expenses categorized as “mental health skill building.” These mental-health services are particularly valuable to the homeless, drug and alcohol addicts, and people coming out of incarceration. Since the enactment of Medicaid expansion, the number of agencies providing such services has increased significantly. And so have the fraudsters who have learned how to game the system.

‘We have seen mental health skill builders drive their clients to our Community Center, sit in the waiting room sometimes for two to three hours while waiting for us to deliver services; meanwhile they are billing Medicaid,” says Sarah Scarbrough, director of REAL LIFE, a nonprofit that serves marginalized populations. Continue reading

Runaway Costs and Hospital Monopolies

Employee contributions to medical insurance premiums (family coverage, 2018 by state — Virginia is the highest. By a longshot.

by James C. Sherlock

Healthcare costs are crowding out other spending by citizens and governments. All Virginians know this. Few understand, though, that their elected leaders in Richmond, who are recipients of huge campaign contributions from hospital interests, bear a significant share of the blame and some are actively working to increase costs further.

Virginia had the highest priced commercial health insurance in the country in 2018. (See chart above.) At $6,597, the 2018 average annual employee premium contribution for family health insurance coverage was the highest in the nation. The premium for single coverage in Virginia was the third highest.

The Affordable Care Act exchange is no better. The Centers of Medicare/ Medicaid database lists 16,900 lines of Silver plans and locations nationally in 2018. Virginia had 22 of the 55 highest priced, including 14 of the top 16. In the worst case in the nation, a 40-year-old couple with two children in the Charlottesville area paid almost $39,000 in premiums in 2018 for the less expensive of the only two family Silver policies available on the ACA exchange. Both were offered by Sentara’s Optima Health. With that policy, their out-of-pocket costs were capped at $14,700. Both policies were HMOs with no coverage for out-of-network providers. It was a Sentara network.

Hospital systems in Virginia’s five largest metro areas, either own their own health plans and insurers or have joined exclusive partnerships with one. Sentara, the largest, controls 63 corporations, 43 of which are for profit. Its non-profit subordinates include Optima Health and Sentara providers except its ambulatory surgery centers, which are for-profit partnerships. Continue reading

How Medicaid Expansion Underwrites Hospital Expansion

Roanoke Memorial Hospital: $300 million expansion thanks to Medicaid

by James A. Bacon

A year after Virginia enacted Medicaid expansion, it’s still too early to tell what impact the initiative will have on public health, medical economists tell Virginia Business magazine. But one thing seems clear enough. The program is injecting enough money into the healthcare sector that major health systems say they have the confidence to embark upon major expansion projects.

Roanoke-based Carilion Clinic is moving ahead with a $300 million expansion to Roanoke Memorial Hospital. Fairfax-based Inova Health System is spending a similar amount, $300 million, to upgrade its Loudoun County hospital. Bon Secours Virginia Health System has announced plans for $119 million in improvements to its Chesterfield County medical center. And community health centers are either opening or expanding in Southern and Southwest Virginia.

One big question I had about Medicaid expansion is the impact it would have on hospital profitability — and what the hospitals would do with the money. The Virginia Business article provides some clues. Continue reading

Virginia Health Rank Improves to 15th Best

Source: America’s Health Rankings

by James A. Bacon

Virginia has improved from 20th place last year to 15th place this year among the 50 states in America’s Health Rankings compiled by the United Health Foundation. The report cited the Commonwealth as one of three states that “made the largest improvements in the rankings since 2018.” (See the Virginia health profile here.)

Virginia strengths: a low crime rate, a low percentage of children in poverty, and high immunization coverage among children. Since 2012, smoking has decreased from 20.9% of adults to 14.9%. Air pollution has decreased, and so has infant mortality.

Virginia challenges: a low rate of mental health providers, low per capita public health funding, low meningococcal immunization among adolescents. Drug deaths are up, frequent mental distress has increased, and so has the rate of chlamydia.

Overall, the story is a positive one. To what does the Commonwealth owe this improvement? Continue reading

In Failure, the GOP Has an Opportunity to Reinvent Itself

Todd Gilbert, House Majority Leader and soon-to-be House Minority Leader: GOP must learn to appeal to suburban voters.

by James A. Bacon

So, the Republicans have wrapped up their annual “Advance” — a retreat at the Omni Homestead resort in Bath County. And if reports of the two newspapers that covered the event are to be believed — one from the Washington Post and one from the Roanoke Times — GOP leaders have absolutely no clue how to become competitive statewide.

Attendees do agree that they got shellacked in the November election, and they share a vague sense that they need to increase their appeal in the suburbs. But their only hope at this point resides in the conviction that Democrats will over-reach with Trump Derangement Syndrome in Washington and enact California-style legislation in Richmond. If voters get buyer’s remorse, they might start voting for Republicans again.

But you can’t defeat something with nothing, and there is no indication in either news account that Republicans gave much thought to what they stood for, other than not being insane. Continue reading

Two Medicaid Updates: Work Requirement, PBMs

By Steve Haner

Medicaid Work – Training Requirement Dead

Disappointing many, thrilling many, and surprising nobody, the Governor of Virginia has openly broken his 2018 promise to couple expanded Medicaid coverage with a work or job training requirement for able-bodied recipients. Moving people out of poverty is no longer the goal.

Governor Ralph Northam was quoted in posted story by the Richmond Times-Dispatch saying:

“Virginians made clear they want more access to health care, not less. Given the changed makeup of the General Assembly and based on conversations with new leadership, it is unlikely Virginia will move forward with funding a program that could cause tens of thousands of Virginians to lose health care coverage.”

To which outgoing Speaker Kirk Cox responded:

“The Governor and I made personal commitments to each other on this long-term public policy agreement. There wasn’t an asterisk that said, “unless my party wins the next election.” It’s a sad reflection on the value of integrity in modern politics.”

Continue reading

Rent Seeking, Runaway Medical Costs, and the Middle-Class Squeeze

Source: The Commonwealth Fund

by James A. Bacon

Mirroring national trends, Virginia healthcare markets are severely out of whack. The main difference is that here in the Old Dominion, they’re even more out of whack than they are for the country as a whole. In 2018, total out-of-pocket medical insurance costs for Virginia employees (employee contribution to premiums + deductible) amounted to $8,143 — 10.2% more than the national average.

That’s on top of what employers pay. According to the latest data compiled by the Commonwealth Fund, employers on average contribute $6,635 for single coverage and $19, 512 for family coverage. Add up the employer and employee share, and the cost of family coverage is equivalent to about $13.30 per hour in earnings for a full-time employee.

These costs have rapidly outpaced the general cost of living. As a percentage of median income, out-of-pocket costs have increased from 6.9% of median income to 10.7%.

Out-of-control medical insurance costs constitute a crisis for Virginia’s middle class. While the public policy debate in Richmond has focused almost exclusively on how to extend insurance coverage to the poor and working poor in the form of Medicaid expansion and Obamacare, nothing more than lip service has been given to the crisis for people who pay their own way. Continue reading

The Issue of Guardianship and the Contribution of a Newspaper

Ora Lomax with a picture of her husband, William, who was committed to a nursing home against her wishes. Photo credit: Richmond Times Dispatch

On Sunday, the Richmond Times-Dispatch ran a remarkable article. It was remarkable both in the amount of space the newspaper dedicated to it, 5½ whole pages, and its subject, guardianship, a subject about which little is known by the public, but that could affect anyone.

The publishing of this series of articles illustrates the continuing value of newspapers. The RTD invested a lot of resources into this story. It was a year-long investigation in which staff combed through the records of hundreds of guardianship cases originating in the Richmond circuit courts. They examined all the public documents related to those cases. They created a database with all the relevant data from those cases. They also looked at some guardianship cases filed in Henrico and Norfolk circuit courts to see how such cases were handled in different jurisdictions. They interviewed dozens of people and attended guardianship hearings. No other media for the general public could, or would, dedicate this amount of resources to a single topic. Continue reading

The Bureaucratic Nightmare of Hospital Billing

by James A. Bacon

It’s not easy going through life with Parkinson’s Disease, afflicted by tremors, stiffness, fumbling hands, and difficulty walking. Carrying on becomes a real challenge when you add debilitating rounds of chemotherapy. That’s the predicament my old friend Lisbeth finds herself in these days: fighting off two terrible diseases at once.

As you can imagine, the last thing Lisbeth needs as she’s trying to keep it all together is to get into a billing quarrel with her hospital. Most people in her condition would be too exhausted to study their hospital bills and spot the errors, much less to contend with an unresponsive hospital bureaucracy to get her money back. Most people would just let it slide. But Lisbeth isn’t like most people. She’s a crusader at heart, and her maladies have not conquered her spirit.

Lisbeth knows I blog about health care from time to time, and she approached me to tell her story. She laid copies of bills, correspondence and her  contemporaneous notes before me and walked me through her healthcare hell. Compared to tales of medical malpractice like amputating the wrong foot or contracting fatal infections in the hospital, this was tame stuff. What struck me, however, was that her complaints, though banal, are likely endemic in the healthcare system. Continue reading

Inmates Need Costly Medical Care, Too

by Dick Hall-Sizemore

In the most recently completed fiscal year, the general fund cost to provide medical care to Virginia prison inmates was $221.6 million.

That is a lot of money by any measure; it exceeds the entire budget of all but a few state agencies. However, despite its size, it does not get much public attention.

Like the state budget, medical costs threaten to consume the DOC budget.  The FY 2019 expenditures constituted more than 18% of the agency’s general fund budget. Each year, the budget request for additional funding for medical services is at the top of DOC’s list. Its FY 2019 appropriation for medical services exceeded its FY 2017 appropriation by $34.8 million. For the upcoming biennium, the agency has requested an additional $21.8 million in the first year and $28.3 million in the second year. Continue reading

Republicans Must Find a New Way Forward

by James A. Bacon

Virginia is a blue state now. Not only do Democrats occupy all statewide elected positions — two U.S. senators, governor, lieutenant governor, and attorney general — with yesterday’s election, they control both houses of the General Assembly.

Republicans got their booties  kicked. And the butt-stomping is not likely to subside. The Dems will control the next redistricting, which will cement their dominance of the legislature. Auguring well for the blue team in the future, the fastest-growing region of the state, Northern Virginia, now is pure blue with bits  of purple on the exurban fringe. By contrast, Republican strongholds in rural Virginia have shrinking or stagnant populations. Also favoring Democrats in the long run is the increasing percentage of racial/ethnic minorities in the state and the declining percentage of whites.

Republicans need to re-define who they are and what they stand for, or they will become a permanent minority. News reports say that dislike of Donald Trump drove Democratic voter turnout, but the Blue Tide is much broader and deeper than voter animus of one man. Take Trump out of the equation after the 2020 election, and Virginia Republicans still have a huge problem.

Can the Republicans re-calibrate? I certainly hope so, because I’m terrified of the Democratic Party agenda of $15 minimum wage, spiking the right-to-work law, a damn-the-torpedoes-full-speed-ahead rush to a 100% renewable electric grid, spending and taxing, taxing and spending, and injecting its grievance-and-victimhood agenda into the consideration of every issue. But Republican priorities on culture war issues — guns, abortion, transgenders — are not winning issues statewide. As long as Republicans remain captive to its rural/small-town base, I don’t see how it can reinvent itself.

What does a rejuvenated Republican Party look like? (Or, if the GOP is incapable of reinventing itself, what does a successor party look like?) Continue reading

The Radioactive Donors In 2019? Healthcare

Money (And Hypocrisy) In Politics

By Steve Haner

The following is one of my “revise and extend” follow-up posts, this one adding detail to an exploration of the raging attacks on Republican efforts to offer alternative health insurance plans.  You can read the original post on the Jefferson Policy Journal.    

Not many months ago, it was a safe bet that by late October the campaign attack ads would focus on utility contributions. There is still time for that to appear. Dominion Energy clearly expected that, as evidenced by a full page, very defensive advertisement in Wednesday’s Richmond Times-Dispatch. Then there is its most cloying television ad yet.

You’ve seen it, of course – the lovely young lady whose Daddy is a deployed Dominion employee. Instead of wearing a U.S. Army or Blue Star cap, she sleeps and poses for school pictures in his Dominion Energy hat. Now, how could a company engendering that kind of love and loyalty be misbehaving?

Continue reading